Association of stage of diabetic retinopathy on intraocular pressure

To determine whether stage of diabetic retinopathy (DR) is associated with increased intraocular pressure (IOP).

The medical records of patients seen in the outpatient ophthalmology clinic at Sidney & Lois Eskenazi Community Hospital in Indianapolis, Indiana, from January 2022 to August 2023 were reviewed retrospectively. The highest IOP of those presenting without type 2 diabetes mellitus (T2DM), T2DM without DR, and varying severity of DR was recorded. Main outcome measures included median and average IOPs recorded from patients who presented without diabetes, diabetes without retinopathy, and mild, moderate, severe nonproliferative and proliferative diabetic retinopathy. Comparisons between groups generated P values, with ≤0.05 indicating statistical significance.

A total of 389 patients (759 eyes) were included. Mean patient age was 58. Male patients accounted for 286 eyes (37.7%); Hispanic patients, for 270 eyes (35.6%); patients identifying as black, for 261 eyes (34.4%); white patients, for 195 eyes (25.7%); and Asian patients, for 33 eyes (4.3%). Overall, analysis showed IOP increased between eyes without T2DM compared with mild nonproliferative DR (P = 0.0373), mild DR compared to moderate nonproliferative DR (P = 0.0117), and moderate DR compared with severe nonproliferative DR (P = 0.0001). The IOP observed between severe nonproliferative DR to proliferative DR (P = 0.5351) was not statistically significant.

In our study cohort, there was a positive correlation between elevated IOP and more advanced stage of DR, indicating that patients with diabetes but no findings of DR on retinal examination seem to be at greater risk of elevated IOP than those with mild-to-moderate DR. These results suggest that IOP in patients with T2DM, with or without DR, should be closely monitored over time to prevent future IOP-related complications.